J&K pushes long-term drug de-addiction rehabilitation to curb relapse rates

Srinagar, Mar 3: Amid rising substance abuse and high relapse rates in Jammu and Kashmir, the government is in the process of comprehensively overhauling the de-addiction framework, with a renewed focus on long-term, community-based recovery and rehabilitation.

As per the Action Plan, a copy of which is available with Greater Kashmir, the proposed reforms aim to redesign the existing system through a structured three-tier care model with standardised referral pathways, expanded infrastructure and enhanced manpower. The approach also seeks to engage field-level healthcare staff in systematic data collection and dissemination of counselling services, while addressing stigma and taboos surrounding drug de-addiction within communities.

“The strengthened system will address major gaps in continuity of care,” the document states.

The new framework places community-level detection at its core. Community health workers, ASHAs, educators, NGOs and peer educators will be tasked with identifying suspected cases of substance abuse and referring them to Primary Health Centres (PHCs) for screening.

Screening at PHCs will be conducted through standardised tools such as ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Mild cases will be managed at the primary level through short interventions and regular follow-ups. Moderate to severe cases will be referred to district hospitals or Addiction Treatment Facilities (ATFs) for specialised care.

At the secondary level, treatment will include counselling, family therapy, medication-assisted treatment, cognitive behavioural therapy (CBT), and life skills training. Short-term admission for detoxification will be provided when necessary.

Following treatment, patients may be discharged back to primary care for continued monitoring, referred to residential rehabilitation facilities, or escalated to tertiary centres depending on the severity and clinical requirements of their cases.

The Action Plan introduces a system of Restrictive Care Rehabilitation, which will provide structured residential treatment ranging from three to twelve months for high-risk patients.

This residential care will run concurrently with counselling, peer support, supervised medication, vocational training and family therapy. Upon discharge, patients will receive tele-psychiatry support to ensure continuity of care. The framework also includes employment support and crisis intervention services to facilitate long-term reintegration and reduce relapse risks.

Tertiary centres will focus on complex and treatment-resistant cases. These facilities will stabilise patients for two to four weeks before referring them back to district-level institutions with clearly defined follow-up plans to maintain treatment continuity.

The Action Plan is critical of the present three-tier healthcare structure, stating that it lacks coordination, standardisation and sustained follow-up for substance use recovery.

At the PHC level, limited counselling services are available but there are no standardised screening protocols. “Case identification often happens incidentally,” the document notes.

At the district level, ATFs offer outpatient psychiatric services and opioid substitution therapy. However, specialist shortages, inconsistent interventions and weak communication with primary care facilities limit effectiveness. The document further highlights that structured psychosocial therapies, family interventions and rehabilitation services remain inadequate.

At the tertiary level — including the Institute of Mental Health and Neurosciences (IMHANS) and Government Medical Colleges — advanced diagnostics and complex case management are available. However, heavy patient loads, centralised locations and the absence of a back-referral system hamper accessibility and long-term follow-up.

The document observes that the current system remains largely facility-based and detox-oriented. “There is little focus on long-term psychosocial recovery, livelihood support, and social reintegration,” it states.

Substance abuse has emerged as one of the most critical public health concerns in Jammu and Kashmir. A 2022 prevalence study conducted by the Institute of Mental Health and Neurosciences (IMHANS), in collaboration with the Social Welfare Department and the Directorate of Health Services, estimated that 67,468 individuals in Kashmir are substance-dependent.

The proposed overhaul seeks to transform the de-addiction ecosystem from episodic detox treatment to a comprehensive recovery-oriented model rooted in community engagement, structured rehabilitation and sustained follow-up.